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Nursing During A Pandemic

Katie DuBoff - September 28, 2020


Faith Aquino ’00 and Katie Dailey ’01 have experienced the highs and lows during the COVID-19 crisis.

By Katie DuBoff and Joe Darrah ‘11

As ironic as it may seem for a registered nurse who works in a cardiothoracic ICU, Faith Aquino ’00 does not consider herself to be an alarmist.
Still, when she came into contact with the first coronavirus (COVID-19) patient to be admitted to Lankenau Hospital, Wynnewood, PA, this past spring, she was worried that it could be the start of what would become an overwhelmed healthcare system in the neighborhood and the surrounding area. The township of Lower Merion had already become known as an early “hotspot” for the virus, and as reports about a lack of personal protective equipment (PPE) sprouted across the country, Aquino was becoming increasingly concerned about all of the unknowns that COVID-19 presents to patients and providers alike.

“The most important thing that we like to focus on is to be a calming presence for our patients,” said Aquino, who has been on staff at Lankenau since 2007. “We all wondered if we would have the proper PPEs and enough of them, ventilators, and other machines. And we wondered if we would need to prioritize who gets what.” Thankfully, nearly six months later, Aquino can say that her hospital has not experienced an overwhelming amount of virus spread or an underwhelming availability of PPE —mainly because of preparedness on the part of the hospital, its administration, and its staff.

“I knew we were going to see COVID-positive patients, but the hospital had already devised a plan to have enough PPE that was rationed and under lock and key to be distributed to all units when they needed it. We have always had the equipment – the masks, the gloves, the face shields – available to protect ourselves and our patients. So it has always felt like things were pretty well controlled during the pandemic.”
In nearby Philadelphia, at the University of Pennsylvania’s Common Center For Advanced Medicine, Katie Dailey ’01, a registered nurse in the operating room, is pleased to relate a similar scenario. Although the threat of the virus brings with it an anxiety that doesn’t totally fade, she has settled into working in an environment that prepared for a mass influx of patients while putting protocols into place that would help to avoid that reality from actually playing out. As part of those procedures, Dailey and her peers from the OR found themselves assisting staff members in higher trafficked departments at the height of the pandemic when elective surgeries were being postponed and resources were needed in other hospital areas. Today, Dailey and Aquino see themselves as more seasoned nurses with added perspectives that they can bring to patients and colleagues. They both recently shared their experiences with Rosemont Magazine and expressed their thoughts about where COVID-19 and healthcare in general may go from here.

Those Initial COVID Days
That first COVID patient admitted onto Aquino’s unit was experiencing the “typical” virus complications — fever, cough, difficulty breathing — was not seeing progress despite being on a ventilator at another hospital, and would require a bit of a radical procedure in an attempt to regain her health. In the cardio ICU, patients can be offered extracorporeal membrane oxygenation (ECMO), a machine that is similar to a heart-lung bypass device that is used during open-heart surgery that pumps and oxygenates blood outside the body while allowing the heart and lungs to rest. As the healthcare community has continued to learn how to attempt treating COVID patients, ECMO has emerged as a viable option, especially as evidence continues to show that the virus compromises, among other body organs, the heart.

“Our unit has the only ECMO-certified nurses throughout the Main Line Health System, so we had beds designated, and we received all of our other hospitals’ transfer patients,” Aquino said. “These patients’ lungs are unable to oxygenate or ventilate properly, so the machine does it for them.”

Though the procedure has proven successful, having COVID patients in close proximity, in particular, to a cardio-compromised population is a great risk. And so patients would be isolated as best as possible, which represents one of the toughest aspects of the pandemic, say Aquino and Dailey.

“These patients can’t have any friends of family in the hospital with them, even when they’re awake,” said Dailey. “And that’s very foreign. So these patients really need you to show them that you care because they don’t have their loved ones around them. The most important thing that we’ve been able to do for these patients is to be nurturing to show that we care about them.”

Dailey, who is now back to being predominately staffed in the outpatient Common Center’s OR, spent several months being asked to lend her services in a variety of ways to help keep spaces available and sanitized for COVID patients. From checking temperatures of those entering the hospital to organizing donations that flowed in from the community, Dailey and others often did not know what each day onsite would be like.

Like Aquino, she said she never felt a sense of panic, primarily because her background exposes her to the risk of contracting diseases such as HIV and Hepatitis C that also require stringent infection control practices. Receiving education on best practices and seeing her nurse peers rally around one another also provides a comforting sense of confidence during this time, Dailey said. “When everything started to unfold, we were instructed to receive as much online training as possible to learn about what we could do in the ICU,” she said. The goal was to train us all to know the basics of the ICU so that we could be helpful. Fortunately, our ICUs never reached maximum capacity and our ICU nurses were never understaffed.”

Taking Next Steps
As numbers have trended downward and various restrictions have been eased, including the opportunity to have elective surgeries, Dailey has returned to her regular nursing role in the OR. However, the general cautious nature continues. “We are as careful as we can be under the circumstances,” Dailey said. “So far, our efforts are working. Our hospital requires a COVID test for every incoming patient to protect us, but there is no guarantee that a patient is COVID-negative.

While the prospect of a vaccine provides hope for the end to the pandemic and a relief of tension, there is not expected to be a quick turnaround. “As we reopen businesses, schools, and restaurants this fall – which I think can be done, albeit slowly – we must continue to take precautions to keep our infection rates at a minimum,” Aquino said. “One thing we know for certain is that the effects of this virus on the body can be devastating and irreversible. We have seen new symptoms emerge over the last few months, and we have to assume anyone has it, given the possibility of asymptomatic carriers. It is better to err on the safe side until we get testing down and collect more data.”

While positivity rates are continuing to decline in Montgomery County and surrounding areas, both Aquino and Dailey agree that face coverings and social distancing are the new normal for the foreseeable future. “Everyone should get used to wearing masks, keeping social distance, and remembering to wash hands frequently,” Dailey said. “We cannot let our guard down when positivity rates are low.”

Aquino and Dailey shared their stories with Rosemont Magazine in the late summer, before positivity rates began to curve back upward.